“This can’t be…”
“Maybe they missed something…”
All of us can relate to the feeling of being overwhelmed by persistent negative thoughts. Thoughts of hopelessness or helplessness make you feel trapped with no place to escape to.
Physical or psychological pain, financial stress, problematic relationships, and past traumatic events are all a part of life. And when you become attached to certain thoughts, they can impact your behavior.
Has rejecting, avoiding or distracting yourself from negative thoughts ever made the pain go away?
Making Pain Go Away, or Making Way?
Traditional cognitive behavioral therapy aims to identify, neutralize, reduce, and revert ‘maladaptive’ cognitions, thoughts, feelings and emotions that frame actions and behaviors. Acceptance and Commitment Therapy (ACT) proposes that we accept the existence of these unpleasant feelings and sensations as a part of life. Instead, we should embrace the idea that struggling with them is not beneficial, especially when they cause further suffering or harm (1).
ACT seeks to cultivate acceptance as opposed to “experiential avoidance” (attempts to avoid thoughts, feelings, memories, images, and physical sensations—even when doing so creates harm) (2). Avoiding negative or unpleasant thoughts and behaviors is a core coping strategy and self-defense. But by giving them no space to resolve, they may grow to become a recurrent source of unhappiness and distress. For physical therapists, assessing whether experiential avoidance is also at the core of their client’s struggles with pain or disability is key to creating a therapeutic plan that works.
Accept What Can’t be Changed, Focus on What Matters Most
Life is a journey where suffering sometimes happens. To survive is to suffer, to live is to find some meaning in the suffering. This is central to Buddhist philosophy, which teaches acceptance of suffering as a starting point to transcend its burden and live a calmer, fuller life (3).
With similarities to Buddhist practices that seek to achieve mindfulness, ‘acceptance’ is one of the six core processes of ACT. The six core processes (Acceptance, Cognitive Defusion, Present Moment Awareness, Self as Context, Values, and Committed Action) depict both the interface between human language and cognition and the control of human behavior by direct experience (4). Through interventions that target these processes, ACT promotes what is known as “psychological flexibility” to alleviate psychological distress and improve functioning (5, 6).
ACT is a third wave psychotherapy that incorporates elements of traditional cognitive behavioral therapy, but instead of seeking to alter thinking patterns, it focuses on changing the stance towards them.
Let it Be (Control No More)
We struggle to understand and find meaning in our complex world. We often desire predictability, repetition and consistency. For things to make sense, we need to feel and be sure that we are in control. When we are not, anxious thoughts and unpleasant emotions may influence or control us instead.
Acceptance in ACT refers to the ability to openly and willingly embrace circumstances over which we have no direct control, in order to pursue the values and goals -either material, affective, or spiritual- that make us feel fulfilled. Advocates of ACT are quick to note that acceptance is not an end in itself; it does not mean self-abandonment or giving up, but rather it denotes healthy resignation to what is(7). Acceptance is also the first necessary step before commitment to positive actions; these being behaviors that allow us exist peacefully, despite grief, worry, anguish, or pain.
Architecting Acceptance and Softening to Openness
Adversity happens. Whether we cope with, learn from, or succumb to it determines its impact on our lives. Being open to accepting and dealing with adversity in a positive light might well be the difference between suffering, and living.
Dr. Tatta’s simple and effective pain assessment tools. Quickly and easily assess pain so you can develop actionable solutions in less time.
Nutrition to Prevent Pain and Disease
Chronic diseases (also called ‘lifestyle’ diseases) are largely preventable; although genetics can increase susceptibility in some people, environmental factors are mostly to blame. Chronic pain caused by musculoskeletal conditions usually restricts physical activity and leads to weight gain; it is well documented that sedentarism, malnutrition, obesity, and smoking, rather than genetic factors, are main precipitating factors of chronic disease (9, 10).
Though more research is needed, the overall results of the meta-analysis appear to be more in line with the main conclusion of one of the studies, which points to disability, rather than osteoarthritis, as the predictor of cardiovascular disease (11).
Seize the Opportunity: A Physical Therapist’s Role
People are living longer, and both musculoskeletal pain and chronic diseases are expected to grow in tandem. Physical therapists are in a unique position to prevent and reduce the burden of chronic disease, disability, and pain by promoting physical activity and healthy nutrition patterns. To help you meet this challenge, valuable insights and resources can be found in my blogs and podcasts.
1- Vos, T., Allen, C., Arora, M., Barber, R. M., Bhutta, Z. A., Brown, A., … & Coggeshall, M. (2016). Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet, 388(10053), 1545-1602.
2- Osteoarthritis Research Society International (OARSI). Osteoarthritis: A Serious Disease. New Jersey: December 2016.
3- Williams, A., Kamper, S. J., Wiggers, J. H., O’Brien, K. M., Lee, H., Wolfenden, L., Yoong, S. L., Robson, E., McAuley, J. H., Hartvigsen, J., … Williams, C. M. (2018). Musculoskeletal conditions may increase the risk of chronic disease: a systematic review and meta-analysis of cohort studies. BMC medicine, 16(1), 167. doi:10.1186/s12916-018-1151-2
4- Jordan, K. P., & Croft, P. (2010). Mortality and cancer in patients with new musculoskeletal episodes: a cohort study. The British journal of general practice : the journal of the Royal College of General Practitioners, 60(572), e105-11.
5- McBeth, J., Silman, A. J., & Macfarlane, G. J. (2003). Association of widespread body pain with an increased risk of cancer and reduced cancer survival: A prospective, population‐based study. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology, 48(6), 1686-1692.
6- Kendzerska, T., King, L. K., Lipscombe, L., Croxford, R., Stanaitis, I., & Hawker, G. A. (2018). The impact of hip and knee osteoarthritis on the subsequent risk of incident diabetes: a population-based cohort study. Diabetologia, 61(11), 2290-2299.
7- Rahman, M. M., Cibere, J., Anis, A. H., Goldsmith, C. H., & Kopec, J. A. (2014). Risk of type 2 diabetes among osteoarthritis patients in a prospective longitudinal study. International journal of rheumatology, 2014.
8- Sokolove, J., & Lepus, C. M. (2013). Role of inflammation in the pathogenesis of osteoarthritis: latest findings and interpretations. Therapeutic advances in musculoskeletal disease, 5(2), 77-94.
9- Booth, F. W., Roberts, C. K., & Laye, M. J. (2011). Lack of exercise is a major cause of chronic diseases. Comprehensive Physiology, 2(2), 1143-1211.
10- Bruins, M., Van Dael, P., & Eggersdorfer, M. (2019). The Role of Nutrients in Reducing the Risk for Noncommunicable Diseases during Aging. Nutrients, 11(1), 85.
11- Hoeven, T. A., Leening, M. J. G., Bindels, P. J., Castaño-Betancourt, M., van Meurs, J. B., Franco, O. H., … & Bierma-Zeinstra, S. M. (2015). Disability and not osteoarthritis predicts cardiovascular disease: a prospective population-based cohort study. Annals of the rheumatic diseases, 74(4), 752-756
6- McCracken, L. M., Chilcot, J., & Norton, S. (2015). Further development in the assessment of psychological flexibility: A shortened Committed Action Questionnaire (CAQ‐8). European Journal of Pain, 19(5), 677-685.
7- Cullen, C. (2008). Acceptance and commitment therapy (ACT): A third wave behaviour therapy. Behavioural and Cognitive Psychotherapy, 36(6), 667-673.